Journal of neurosurgery
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Journal of neurosurgery · Oct 2007
Multicenter StudyIs repeated radiosurgery an alternative to staged radiosurgery for very large brain arteriovenous malformations?
The results of a novel radiosurgical approach to treat large arteriovenous malformations (AVMs) with repeated radiosurgery are presented and discussed. ⋯ Repeated radiosurgery seems to be a viable option for some AVMs considered to be too large for conventional radiosurgical treatment. The incidence of posttreatment hemorrhages seems to be a larger clinical problem than radiation-induced complications.
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Journal of neurosurgery · Oct 2007
Alpha-II spectrin breakdown products in aneurysmal subarachnoid hemorrhage: a novel biomarker of proteolytic injury.
Aneurysmal subarachnoid hemorrhage (ASAH) is a serious event with grave consequences. Delayed ischemic neurological deficits caused by cerebral arterial vasospasm contribute significantly to death and disability. Biomarkers may reflect brain injury and provide an early warning of impending neurological decline and stroke from ASAH-induced vasospasm. Alpha-II spectrin is a cytoskeletal protein whose breakdown products are candidate surrogate markers of injury magnitude, treatment efficacy, and outcome. In addition, all spectrin breakdown products (SBDPs) can provide information on the proteolytic mechanisms of injury. ⋯ Differential expression of SBDPs suggests oncotic necrotic proteolysis may be predominant in acute brain injury after ASAH and cerebral arterial vasospasm.
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Journal of neurosurgery · Oct 2007
Irradiation of cochlear structures during vestibular schwannoma radiosurgery and associated hearing outcome.
The purpose of this study was to measure the dose of radiation delivered to the cochlea during a Gamma knife surgery (GKS) procedure for treatment of patients with vestibular schwannomas (VSs), and to analyze the relationship between cochlear irradiation and the hearing outcome of these patients. ⋯ During GKS for VSs, relatively high doses of radiation can be delivered to the cochlea. Worsening of hearing after GKS can be the consequence of either radiation injury to the cochlea or the irradiation dose delivered into the auditory canal, or both.
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Journal of neurosurgery · Oct 2007
Seizure freedom after functional hemispherectomy and a possible role for the insular cortex: the Dutch experience.
The authors undertook this study to identify predictors of persistent postoperative seizures in their group of 28 Dutch pediatric and adolescent patients with medically intractable epilepsy who underwent functional hemispherectomy. ⋯ In this group of Dutch pediatric and adolescent patients, residual insular cortex was positively correlated with persistent postoperative seizures. Given the small sample size in this study, however, caution should be used in drawing conclusions about the role of the insular cortex.
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Journal of neurosurgery · Oct 2007
Case ReportsLoss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report.
The authors report a case in which a 62-year-old woman with a history of subarachnoid hemorrhage due to a ruptured aneurysm was found to have a de novo paraclinoid aneurysm in the right internal carotid artery during a routine medical examination. Surgical clip placement was performed via a contralateral pterional approach under visual evoked potential (VEP) monitoring. The superior hypophyseal artery (SHA) was found to originate from the aneurysm body. ⋯ The clip was applied to the aneurysm body to preserve the origin of the SHA. The patient did not have any deterioration of vision after surgery. Intraoperative VEP monitoring can be used to help determine whether the SHA can be sacrificed safely.